HomeMy WebLinkAboutMortgage_Hertel,,,pa, STATEMENT OF MORTGAGE OR CONTRACT
.�e,a�.` INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
a..�
` VALUATION State Form 43709 (1-90) Prescribed by the
State Board of Tax Commissioners
� �
Filina fee $1.00
Irtstructions for filing: Y�� � � � ����
To be fileii in person or by mail with the County Auditor of the county where the �. fi 1997 '\
property is located during the 12 months before May 11 of ihe year the deduction
is to be effective. See r�ver�e for additional instructions and qualifications.
. q'�'
67 G!5SOk �GU Tv AUDITOR
Applican,t�(.4wner or cont act buyer - see restrictions on reverse)
�1 O �l r1 � �2 �
Tax�in� D;stri IC�� Key Number/Legal Description Record No. 9 G
y''l"��C�
— � / (o J�.3 —O � Page No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of March 1, current year. equitable owner? O yes O no
�
If no, what is his/her exact share or interest? If owned with someone other than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
,r'�-*ie of mortgagee or contract seller
1l� � Q � � d�1. �. ,
Address of mortgagee or contract seller
2�
Name of Assignee or other owner or holder of Mortgage.
Address of Assignee
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 9 19�pc7 19 19�(ZOi- �8'ODa2�,�i�/Z ��3 �d0
5 -ati�b� 6-aa-��. —
Signature Secretary of Board of Review Dat� a�P
�-��.'. 6— z 9 —9P �a� �a � p`1 ;��
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
s waslwere a resident of Indiana and owner of the aforementioned property on March 1, 19
S� at (own� full. name) Person authorized by duly executed Power of Attorney or
���'r� by IC 6-1.1-12-.07).
Full Resident Address of Aplicant Address of Authorized Person
%�22.t��1 �ox l7y 1"r:,r�c� -E.�v. =N 'i7G